Breastfeeding/Lactation Consultant

Also, did the LC use a special scale that can calculate the breast milk intake? If so you can probably rent one from her. They are awesome in a situation like this b/c you can exactly measure the baby's breast milk intake during bf sessions and supplement the exact right amount, not too much and not too little. The scale can also be used for weight checks to monitor the baby during the transition time when you gradually wean from the supplement.

Tell me what the weight gain pattern is like and exactly how much formula and ebm you are giving each day and how often you are bf. The baby may not want to feed more frequently b/c of the formula supplement which will stay in her tummy longer b/c it is harder to digest.

BTW, what did the LC see as the problems with weight gain in the beginninng? What was her diagnosis?

I Usually teach moms to reduce formula and ebm supplements gradually over time. I usually recommend starting this only when a good weight gain pattern has been established and any bf concerns have been addressed.

I usually recommend pumping with an electric rental pump with a double kit to maximize your pumping and working to pump enough to make as much of the supplement ebm as possible b/c every ounce of formula you give the baby is teaching your breasts not to make that amount of breast milk. If you give 10oz a day of formula your breasts will make 10oz less than your baby needs, unless you are pumping 10oz. (and of course if you were pumping 10oz you would be giving that instead of the formula) The breasts know how much to make by how much is taken out of the breast. For example if your baby needs 25oz of milk per day and you give 10oz of formula your breasts will learn to make only 15oz. They will not begin to make more unless you take away some of the formula. You can not always wait for the supply to pick up to decrease the formula, you often need to decrease the formula to make the breast milk supply increase.

Now I would not want you to drop the supplements suddenly since that would put your baby at risk for not gaining and would not give your breasts a chance to make up the difference. But if your baby is bf well and has established an appropriate weight gain pattern, you can safely increase the supply by slowly reduce the formula supplements.

Here's the method I use with moms in similar situations as yours...understand this is only an example and you should be closely followed by your pediatrician and hopefully an experienced LC too.

Start recording the amounts you give via the bottle and total it each day so you know how many ounces per 24 hours you give via the bottle, record how much is ebm and how much is formula. Also, record the wet and soiled diapers. As you increase the breastmilk and reduce the formula your baby will probably start to poop more since breastmilk will loosen the stools.

After you have an idea how much she gets each day via bottle start to systematically reduce that amount, starting with reducing the formula first(reduce the ebm via bottle last). So, for example: if she gets 10oz of formula and 4 oz of ebm per 24 hours via the bottle her 24 hours total is 14oz of supplement. You should of course continue to put her to the breast as much as possible during this process, at least 8 times in 24 hours. On day 1 to 3 give her only 13oz via the bottles in 24 hours, give whatever you have of ebm and make up the difference with formula..so it might be 4oz of ebm and 9oz of formula. Don't give more, keep putting her back to the breast if she needs to eat more. If her diaper count does not reduce from what it has been, on days 4-6 give her only 12 oz of milk in bottles per 24 hours. Say you have 5oz ebm and 7oz of formula each day. Again if the diaper count stays the same or more drop more from the daily 24 hour total of bottled milk, and you can start to increase the rate of reducing the supplements if it is going well for example to 10oz on days 6-7, maybe 6oz would be ebm and 4oz of formula. Continue to reduce the daily total in the bottles by about 1-2 ounces every 1-3 days as long as the diaper count is good. When reducing the 24 hour total you can reduce the amount in each bottle or reduce the number of bottles or a combination of both...the important factor is reducing the 24 hour total. When you get to the point that it is only ebm in the bottles you can drop the bottles much faster. This is a flexible process, you can reduce the amounts in the bottles faster if it is going well and the diaper count and weights are good or reduce more slowly if it seems as though the diapers are dropping and the weights are not as they should be. But you must keep good records so you know where you are in the process.

I hope this method was clear. You should also get the baby weighed AT LEAST every week or more frequently as the ped recommends until the transition to the breast is complete and then one more weight check one week after the baby is totally on the breast. That way you will be reassured the baby is "getting enough" through this process and have the confidence to keep reducing the bottles.

It is very possible for you to increase your milk supply at this point. Many moms who get off to a rough start eventually have a complete milk supply, you just need the right help. Keep me updated and get back with questions.

Warmly, Kathy

Here's the info you asked for:

Baby's Weight Pattern

3/3 (birth) 8 lb 0 oz
3/6 8 2
3/8 7 14 (day after leaving hosp.)
3/11 8 3
3/17 8 2 (ped said I should start supplementing more)
3/18 8 4 1/2
3/21 8 3 (ped said I should feed her every 2 hours; panicked: started almost total formula)
3/24 8 12 (9 oz gain in 3 days!)
4/1 9 7
4/10 9 13

On 4/8 I saw the LC and started the new plan for aggressively BF'ing more. Currently am BF-ing about 6 times a day (baby doesn't really request to eat often). She takes 1-2 oz of formula (50/50 with EBM)after a feeding. LC didn't say anything about baby's weight gain in the beginning.

Thanks for your help!

Hi Heather, I’m the board LC and I’m going to add a bit. Some is likely to be repeats of information you already got.

I’m going to reprint some of your words in blue, my words will be in black, and questions to you in red.

Can you give me your baby’s weights so far that you know of? And date of birth and birth weight?

Unless you are using one of the special (usually rental) scales before and after each feeding you can’t really accurately assess his breast milk intake during a feeding. The same applies to the LC.

I usually recommend pumping for at least 10 minutes and then if you are still getting a flow at 10 minutes continue until there is no flow and add 2-5 minutes after the last time you see a flow. Usually this take somewhere between about 10-20 minutes. I know it’s a lot of work when you add feeding the baby and taking care of all you need to do but it will be worth it in the long run if you can pump after each feeding until you don’t need supplement.

That’s not a problem, many women don’t notice breast fullness. Don’t judge milk supply by breast fullness. Here’s a post that describes how to know your baby is getting enough at the breast.

http://parenting.ivillage.com/baby/bbreastfeed/0,,8rr83zjm,00.html

I think the fact that he’s fussy anyway, even after supplemental milk suggests that the fussiness isn’t just an issue of not getting enough to eat. Here’s a post on normal breastfeeding patterns:

http://parenting.ivillage.com/baby/bbreastfeed/0,,8n69dpmw,00.html

I’m so glad you are working with an LC in person. Can you tell me what she felt was the problem with the weight? Did she explain the latch and help you achieve the very best (deepest) latch possible?

Here’s a post on latch to help you assess your latch while continuing to work with the LC:

http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppbreastfeed&msg=77538.10

If he’s only one week old that may be ok. For example: If his birth weight was 6lbs 9oz he could reasonably lose up to 10% which would take him down to 5lbs 10.5oz. Most babies lose about 7% but we don’t usually worry (unless something else is going on) until the baby hits about 10%. A 7% loss would have taken your baby down to about 6lbs 1.5oz. If the baby went all the way down to 5lbs 14.5oz at about 3-4 days old and then went back up to 6lbs 2.5oz at the end of the week might really represents a gain of 4oz in a 3-4 days which is closer to 1oz per day which is fine. The baby isn’t expected to regain to birth weight until about 2 weeks.

If he continues to have good diapers and has all along that suggests he’s been getting enough to eat. Why was supplementation recommended?

Also, I have no nipple pain anymore and no smacking or clicking sounds.

If you had painful nipples that suggests your latch might have been too shallow and they may have inhibited the baby’s ability to obtain the milk effectively. Is that why the LC suggested supplement. Was she able to help you correct the latch?

Baby seems to be latching on nicely but isn't swallowing nonstop. he stops and starts alot with a lot of sucking in between.

It’s ok if he’s not swallowing non-stop. Sometimes babies swallow more quietly. If the baby is sustaining a suck nicely that is in my mind the equivalent of hearing swallows. A sustained suck means his jaw will make a wide movement up and down very rhythmically. He should be able to take short pauses that last no more then about 5-10 seconds and start sucking again after a pause with little or no stimulation.

No, you should not have to keep up this routine forever.

How do you know that he takes 1oz per feeding consistently? If the LC is only doing one test weigh that may not be a reflection of what the other feedings are like. The only way to know his overall intake at the breast is to test weigh before and after ALL feedings in a 24-48 hour period with the specialized scales.

Your pump volume is good. What kind of pump are you using?

I don't feel like I can keep up with the pumping, it's too much for me with my hubby going bac kto work and a 2yr old to chase after so I am going to BF and supplement for as long as my supply will let me!

I understand how difficult it must be to keep up with the routine you are trying to do. However, realize that as you use formula you are reducing your supply to the degree that you use it. Every ounce of formula you give teaches your breasts not to make that amount. If your baby needs 25oz per day of milk and you consistently give 10oz of formula your breasts will not make up the difference and you will only make 15oz of breast milk per day. Here’s a post that describes how to gradually reduce supplements and ensure the baby will get enough to eat and the breasts will make up the difference. This process works best when you can pump but it can be done without pumping, it will just usually take longer if you don’t pump.

http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppbreastfeed&msg=63103.3

Your LC should have shown you what to do to get the baby to suck more effectively. If suck training is needed she should have/would have shown you that. Some babies suck better as the milk supply improves so her idea may be to get you to increase supply via pumping and continued breastfeeding. Don’t forget the most important aspect of increasing supply is taking more milk from the breasts. The way to take more from the breast is to pump and/or remove the supplement slowly so the baby is encouraged to take more from the breast via breastfeeding.

One thing that can help with waking is to make sure the baby is fully awake prior to breastfeeding. Try not to put him to the breast as soon as you get him awake. After you stimulate him to wake him, try to lay him down ‘hands off’ for a minute or so and see what he does. If he falls right back to sleep he’s not awake enough and needs more stimulation. If he remains awake and roots when you tickle his lips with your finger he’s likely in a better awake state to begin breastfeeding.

Sometimes doing lots of skin to skin contact helps the baby get more interested in breastfeeding and feeding effectively.

That would help stimulate supply and might help him suck better at the breast.

Absolutely if supplement is needed, it certainly doesn’t mean it’s forever and you won’t meet your goal to breastfeed.

The breasts adjust milk supply up and down pretty rapidly at this time. There is no way to know exactly how long. As I said before the dip in supply will reflect the amount of formula supplement you use. Your milk supply will only come up if you take more milk from the breasts. Either by the gradual reduction of the formula supplement when the baby is ready. and/or pumping.

Great work!!

Did you decide to stop the pumping b/c it was too much to do or is there another reason? Don’t forget to keep track of how much supplemental formula you give each day and then as the weight becomes more appropriate you can begin the process of reducing it gradually.

Keep us posted. You are doing a fantastic job in a tough situation. Hang in there it will get better/easier.

Just a couple of comments from my personal experience.

With DS#2, he had a problem with his neck which made it nearly impossible to get him to suck. He would scream, latch, then go quiet and motionless, like he was sleeping again. It may be worth it to take the baby to a chiropractor just for a once over to rule out any problems like that.

And with DS#3, I had to supplement until 3.5 months, when I was able to wean him completely off formula. It may take a while, but it's worth it. I'm glad I did both, because it meant a happy baby, and happy mom. In my case, it just took that long for my milk to finally catch up with the baby.

Just experience, not book training,
Hope it helps,
Freddie :)

Oh yeah, may be TMI, but if you're still bleeding big clots, or red blood, there may still be placenta inside your womb, which also (in my experience) affects milk supply. I had a D&C at 6 weeks with DS#1, and then my milk came flying in just afterward.